Does board certification in a medical specialty guarantee good care?

Board Certification Does Not Guarantee Good Care

Board certification is an important marker of expertise and is associated with better patient outcomes, but it does not guarantee good care—quality of care depends on multiple factors including ongoing clinical performance, experience, and practice patterns. 1, 2

The Evidence on Board Certification and Quality

What Board Certification Actually Demonstrates

• Board certification demonstrates comprehensive training, knowledge, and skill in a specialty, as recognized by the American College of Emergency Physicians for ABEM/AOBEM certification. 3
• The ACC/AHA Task Force explicitly states that "board specialty certification is not a required part of these recommendations but is another measure of expertise." 3
• Board certification serves as "one marker" of expertise, but the AHA/ACC acknowledges that "there are expert clinicians who are not board-certified, including those whose expertise was acquired before the development of formal certification programs and those trained outside the United States." 3

Direct Evidence Linking Certification to Outcomes

The evidence shows modest but real associations:

• Patients of board-certified internists and cardiologists had lower mortality rates following acute myocardial infarction compared to non-certified physicians. 1
• Patients of surgeons certified by the American Board of Surgery experienced lower mortality and morbidity rates following segmental colon resection. 1
• Board certification has been associated with improved outcomes in obstetrical care, surgical mortality, and fewer malpractice claims. 1
• In general, board-certified physicians provide better patient care, though the results have modest effect sizes and are not unequivocal. 2

Critical Limitations in the Evidence

The relationship between board certification and actual quality of care has significant gaps:

• As of 2005, the American Gastroenterological Association explicitly stated "there are no data linking successful completion of ABIM recertification in gastroenterology to quality of gastroenterology care," a gap that extends across internal medicine specialties. 1
• The correlation between certification exam results and actual clinical performance shows only moderate association, with correlation coefficients between 0.55 and 0.59. 1
• Despite lack of direct evidence, employers and the public increasingly rely on board certification as an indicator of quality, though these administrative markers were historically more representative of utilization than quality. 1

Quality of Care Depends on Multiple Factors Beyond Certification

Experience and Ongoing Performance Matter More

• The American College of Emergency Physicians states that "the quality of care delivered by legacy emergency physicians should be a primary determinant of their hospital privileges and credentialing," not certification status alone. 3
• ACEP explicitly supports that "legacy emergency physicians should not be forced out of the workforce solely on the basis of their board certification status." 3
• Other qualifications include "objective measurement of care provided; sufficient experience; prior training; and evidence of continuing medical education." 3

Certification Status Can Be Misleading

• Board certification is "excellent but not the sole benchmark for decisions regarding an individual's ability to practice emergency medicine." 3
• The Joint Commission requires that privileges be based on "assessment of applicants against professional criteria," not certification alone. 3
• Substantial variations exist in adherence to evidence-based guidelines even among board-certified physicians, with registry studies showing these variations are associated with differences in outcomes. 4

Common Pitfalls to Avoid

Do not assume board certification equals competence in all clinical scenarios:

• Certification demonstrates knowledge at a point in time but does not guarantee ongoing clinical performance or adherence to evidence-based practices. 4, 2
• A negative outcome alone does not indicate professional negligence, and negligence cannot be inferred solely from an unexpected result—even in board-certified physicians. 4
• Continuous monitoring of treatment standards and outcomes is necessary regardless of certification status. 4

Do not dismiss non-certified physicians with extensive experience:

• Many expert clinicians acquired expertise before formal certification programs existed or through alternative pathways. 3
• Quality metrics and objective performance measures should be the primary determinants of clinical privileges. 3

The Bottom Line for Clinical Practice

Board certification should be viewed as one component of a comprehensive assessment of physician quality, not as a guarantee of good care. Ongoing performance monitoring, adherence to evidence-based guidelines, continuous medical education, and objective quality metrics are more reliable indicators of actual care quality than certification status alone. 3, 1, 4, 2

The public values board certification highly, and it does correlate with better outcomes on average, but individual physician performance varies significantly regardless of certification status. 5, 6